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. 2015 Mar 2;22(10):1262–1271. doi: 10.1177/1933719115574345

Figure 4.

Figure 4.

A model for risk reduction in epithelial ovarian tumors following tubal ligation. (A) We propose that the progenitors of the distal fallopian tube are normally cycling. This may allow for accumulation of genetic mutations that lead to serous cancer initiation, such as inactivation of tumor suppressors BRCA1, BRCA2, and p53. It has been proposed by other studies that when the fallopian tube is left intact, ascending endometrial cells are able to migrate and implant onto the ovary, which may lead to the development of endometrioid and clear cell cancers. (B) Our findings suggest that tubal ligation induces a state of quiescence in epithelia of distal fimbria by leading to a decreased population of progenitor cells with a lower proliferative index. A diminished number of proliferating progenitors may lower the frequency of cumulative genetic changes associated with serous cancer. As others have previously proposed, tubal ligation may prevent the migration of endometrial cells from initiating endometrioid and clear cell cancers on the ovary by interrupting the conduit between the uterus and ovary.